Childhood obesity: a risk factor for injuries observed at a level-1 trauma center

Rana, Ankur R.; Michalsky, Marc P.; Teich, Steven; Groner, Jonathon I.; Caniano, Donna A.; Schuster, Dara P.

doi:10.1016/j.jpedsurg.2008.11.060

« Previous Next »Journal of Pediatric Surgery
Volume 44, Issue 8 , Pages 1601-1605, August 2009

Childhood obesity: a risk factor for injuries observed at a level-1 trauma center

Ankur R. Rana
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA
Marc P. Michalsky
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA
- Corresponding author. Tel.: +1 614 722 3915; fax: +1 614 722 3903.
Steven Teich
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA
Jonathon I. Groner
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA
Donna A. Caniano
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA
Dara P. Schuster
- Department of Internal Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA

Received 20 August 2008; received in revised form 26 November 2008; accepted 28 November 2008.

Abstract

Purpose

Obesity is an independent risk factor in trauma-related morbidity in adults. The purpose of this study was to investigate the effect of obesity in the pediatric trauma population.

Methods

All patients (6-20 years) between January 2004 and July 2007 were retrospectively reviewed and defined as non-obese (body mass index [BMI] <95th percentile for age) or obese (BMI ≥95th percentile for age). Groups were compared for differences in demographics, initial vital signs, mechanisms of injury, length of stay, intensive care unit stay, ventilator days, Injury Severity Score, operative procedures, and clinical outcomes.

Results

Of 1314 patients analyzed, there were 1020 (77%) nonobese patients (mean BMI = 18.8 kg/m²) and 294 (23%) obese patients (mean BMI = 29.7 kg/m²). There was no significant difference in sex, heart rate, length of stay, intensive care unit days, ventilator days, Injury Severity Score, and mortality between the groups. The obese children were significantly younger than the nonobese children (10.9 ± 3.3 vs 11.5 ± 3.5 years; P = .008) and had a higher systolic blood pressure during initial evaluation (128 ± 17 vs 124 ± 16 mm Hg, P < .001). In addition, the obese group had a higher incidence of extremity fractures (55% vs 40%; P < .001) and orthopedic surgical intervention (42% vs 30%; P < .001) but a lower incidence of closed head injury (12% vs 18%; P = .013) and intraabdominal injuries (6% vs 11%; P = .023). Evaluation of complications showed a higher incidence of decubitus ulcers (P = .043) and deep vein thrombosis (P = .008) in the obese group.

Conclusion

In pediatric trauma patients, obesity may be a risk factor for sustaining an extremity fracture requiring operative intervention and having a higher risk for certain complications (ie, deep venous thrombosis [DVT] and decubitus ulcers) despite having a lower incidence of intracranial and intraabdominal injuries. Results are similar to reports examining the effect(s) of obesity on the adult population.

Key words: Childhood obesity, Trauma, Outcomes